Haven of Show Low

Freedom from Abuse, Neglect, and Exploitation Deficiencies

Protect each resident from all types of abuse such as physical, mental, sexual abuse, physical punishment, and neglect by anybody.

Quality of Life and Care Deficiencies

Provide appropriate pressure ulcer care and prevent new ulcers from developing.

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Smoke Deficiencies

Ensure smoke barriers are constructed to a 1 hour fire resistance rating.

Resident Assessment and Care Planning Deficiencies

Ensure services provided by the nursing facility meet professional standards of quality.

Quality of Life and Care Deficiencies

Provide appropriate treatment and care according to orders, resident’s preferences and goals.

Pharmacy Service Deficiencies

Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Nutrition and Dietary Deficiencies

Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Emergency Preparedness Deficiencies

Develop and maintain an Emergency Preparedness Program (EP).

Emergency Preparedness Deficiencies

Conduct risk assessment and an All-Hazards approach.

Emergency Preparedness Deficiencies

Develop Emergency Preparedness policies and procedures.

Emergency Preparedness Deficiencies

Establish staff and initial training requirements.

Emergency Preparedness Deficiencies

Conduct testing and exercise requirements.

Emergency Preparedness Deficiencies

Implement emergency and standby power systems.

Smoke Deficiencies

Install an approved automatic sprinkler system.

Smoke Deficiencies

Inspect, test, and maintain automatic sprinkler systems.

Smoke Deficiencies

Properly select, install, inspect, or maintain portable fire extinguishes.

Gas, Vacuum, and Electrical Systems Deficiencies

Have a battery powered remote alarm panel in a location accessible by operating personnel.

Gas, Vacuum, and Electrical Systems Deficiencies

Have generator or other power source capable of supplying service within 10 seconds.

Resident Rights Deficiencies

Allow residents to self-administer drugs if determined clinically appropriate.

Resident Rights Deficiencies

Honor the resident's right to share a room with spouse or roommate of choice and receive written notice before a change is made.

Resident Assessment and Care Planning Deficiencies

PASARR screening for Mental disorders or Intellectual Disabilities

Resident Assessment and Care Planning Deficiencies

Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.

Quality of Life and Care Deficiencies

Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Quality of Life and Care Deficiencies

Provide for the safe, appropriate administration of IV fluids for a resident when needed.

Pharmacy Service Deficiencies

Ensure each resident’s drug regimen must be free from unnecessary drugs.

Quality of Life and Care Deficiencies

Provide or obtain dental services for each resident.

Violation cited

Based on observation, the facility failed to protect the entire facility with an automatic sprinkler system. This would result in the sprinkler system not being able to extinguish the fire and could result in injury or death to the building occupants.

Based on a record review and interviews, the facility failed to provide all required fire drills per NFPA 101. Failing to conduct fire drills in accordance with the life safety code, one per shift per quarter under varied conditions, to familiarize staff with conditions under an actual fire, can result in harm to all residents and/or staff during an actual fire or emergency situation.

Based on record review and interview with staff, the facility failed to have written documentation of the Annual Inspection and Testing of Door openings in accordance with NFPA 80, 2010 Edition, "Standard for Fire doors and Other Opening Protectives." Failing to inspect and test fire-rated door assemblies in accordance with NFPA 80 annually could cause harm to all staff and residents in the effected areas.Â

Based on observation and staff interviews, the facility failed to ensure that appliances are directly plugged into wall outlet receptacles and not power strips. The use of multiple outlet adapters could create an overload of the electrical system and could cause a fire or an electrical hazard. A fire could cause harm to the patients and staff .

Violation cited

Violation cited

Violation cited

Violation cited

Based on observation the facility failed to properly fill penetrations in a fire/smoke barrier in the facility. Failing to seal the penetrations, holes, and openings in the fire/ smoke barriers will allow smoke and heat to penetrate other wings or possibly the whole facility which could cause harm to the patients in the time of a fire. NFPA 101 Life Safety Code, 2012, Chapter 19, Section 19.3.7.3 "Any required smoke barrier shall be constructed in accordance with Section 8.5 and shall have a fire resistance rating of at least \'bd hour." Chapter 8, Section 8.5.6.2 Penetrations for cables cable trays, conduits, pipes, tubes, vents wires and similar items to accommodate electrical, plumbing and communications systems that pass through a wall, floor or /ceiling assembly constructed as a smoke barrier, or through the ceiling membrane of the roof /ceiling of a smoke barrier assembly shall be protected by a system or material capable of restricting the transfer of smoke. Findings include: Observations made while conducting a complaint investigation for intake #'s AZ00218150 and AZ00218152 on November 04, 2024, revealed that the facility failed to maintain the fire/ smoke barrier in the following area: The fire/smoke barrier in the attic at the 200 hall junction and the common area at the main entrance had a large hole in the drywall as well as perforations that were not properly sealed where piping extended through the wall. The management team acknowledged during the attic tour and exit conference on November 04, 2024, that the fire/smoke barrier at the 200 hall junction and the common area at the main entrance had a large hole in the drywall as well as perforations that were not properly sealed where piping extended through the wall.

Based on the clinical record, employee records, staff interviews, and the facility policy and procedures, the facility failed to ensure that staff (#13 and #18) received the required training needed to provide care for resident (#22). Findings include: Resident #22 was admitted to the facility on December 6, 2021 and readmitted on April 24, 2024 with diagnoses that included hemiplegia and hemiparesis following a cerebral infarction affecting the the left non-dominant side, aneurysm of unspecified site, and epilepsy. The minimum data set (MDS) date August 1, 2024 included a brief interview for mental status score of 12 indicated the resident was moderately cognitively impaired. It also included that the resident used a wheelchair and required partial/moderate assistance with sitting to standing, transfers, and upper and lower body dressing. The activity of daily living care plan revealed that the resident had a performance deficit related to a history of cerebral vascular accident (CVA) with hemiplegia, and left upper extremity contractures. Interventions included one staff participation to reposition and turn in bed and to use the call-light for assistance. The care plan revealed that the resident was also at risk for falls related to left upper extremity contracture, episodes of confusion, gait/balance problems, and psychoactive drug use. It also included that the resident had a fall. Interventions included to have the bed in a low position, may require increased help with transfers, and to educate the resident, family, and care givers about safety reminders and what to do if a fall occurs. A progress note dated August 29, 2024 revealed late entry documentation that the nurse was notified that the resident had fallen in her room. Upon entering the room, the resident was found laying on her left side in front of her bed. The resident did not have her call-light on at the time and did not ask staff for assistance prior to attempting a self transfer. Two certified nursing assistants (CNAs) were already in the room, they had placed a pillow under the resident's head and were starting to get vital signs. The resident reported that she had hit her head on the left side and was adamant about going to the hospital to be evaluated. The resident stated that she had attempted to transfer from her bed to her wheelchair and the wheelchair slipped out from under. The brakes on the wheelchair were not locked. The resident was assessed and found to have redness/abrasions to her left rear shoulder, left cheek and left elbow. Review of the Discharge Transfer Summary Assessment dated August 29, 2024 revealed that resident #22 was transferred to the hospital. The resident had a fall after an attempted transfer from her bed to her wheelchair. The resident reported that she hit her head and requested to be sent to the emergency room. The resident was assessed and red areas were noted to her left cheek, left elbow and shoulder. The resident was helped into her wheelch

Based on documentation, staff interviews, and the facility policy and procedures, the facility failed to ensure one resident (#56) received medical care treatments ordered by the physician. The deficient practice could result in residents not improving. Findings include: Resident #56 was admitted to the facility on August 29, 2024 with diagnoses that included enterocolitis due to Clostridium Difficile (Cdiff), urinary tract infection (UTI), neuromuscular dysfunction of the bladder, and Parkinson's Disease. The minimum data set (MDS) dated September 9, 2024 included a brief interview for mental status score of 11 indicated the resident was moderately cognitively impaired. It also included that the resident did not reject care during the look-back period. The care plan dated August 29, 2024 revealed that the resident had infections, Clostridium difficile and urinary tract infection. Interventions included contact/droplet precautions, and educating the resident and staff regarding preventative measures to contain infections. Use as much disposal equipment and dedicated equipment as possible. Non-disposable resident care equipment to be appropriately cleaned and disinfected per facility protocol. The care plan dated August 30, 2024 revealed that the resident had enhanced barrier precautions related to a central line/PICC, indwelling catheter. Interventions included to don and doff gown and gloves and to perform hand hygiene as per facility protocol. A care plan dated August 30, 2024 revealed that the resident is at risk for skin impairment due to decreased mobility and included the interventions to administer treatments as ordered and monitor for effectiveness. An oxygen therapy care plan dated August 30, 2024 revealed oxygen therapy related to ineffective gas exchange included an intervention to provide oxygen per physician order and to monitor for signs and symptoms of respiratory distress and report to the medical doctor. Review of the Order Summary revealed: -August 29, 2024, Vancomycin HCI oral capsule 125 mg give one capsule by mouth every 6 hours related to enterocolitis due to Clostridium Difficile for eight days. -August 29, 2024, Amoxicillin oral capsule 500 mg give one capsule by mouth every 8 hours related to UTI. Discontinued on September 10, 2024. -August 29, 2024, Foley catheter size 16 french, 10 cc balloon. Different size may be inserted if size ordered cannot be reinserted. Change Foley catheter as needed for leaking, soiling, blockage or as ordered by provider. Discontinued September 2, 2024. -August 29, 2024, Nystatin External Powder 100000 unit/gram (topical). Apply to affected areas topically every shift for skin care. Discontinued September 21, 2024. -August 29, 2024, Catheter care with soap and water or wipes every shift for other. Discontinued on September 21, 2024. -August 29, 2024, oxygen at 0-5 liters per minute as needed to keep saturation above 89% every shift for oxygen therapy. Discontinued September 21, 2024. -Septemb